Walking out

Yesterday this little boy’s dad brought him in, begging me to cut off his arm.

                       
It's been getting worse over the last year and parents are afraid that it is going to spread to the rest of his body. I told them to return next Monday for further workup including TB and filariasis, which will have to be drawn overnight. I don't think there is much we can do, but maybe we can stop it from spreading. 

His pinky is purple because it shows he has had a recent polio vaccine. Kids here get them about every month, and the marker on the finger is to prevent them from getting more than one in a month. Parents are desperate for their children to get vaccinated as soon as possible, maybe we can send California's unused ones over here. 

We've been seeing a ton of cerebral malaria recently. These kids come in looking SO BAD. Often completely unresponsive. Thursday evening I was doing a spinal tap on a comatose 7 year old, this morning he was sitting up in bed eating rice. It's amazing what antimalarials can do. It's scary to think that there are places that may not have these medications available. How many of these children die at home?

Often patients go to traditional healers before presenting to the hospital and we're never quite sure of what "country medicine" the patient took prior to presenting to us. On the adult ward they see a fair amount of liver failure attributed to country medicine, often leading to death. Last night we admitted a 6yo boy who looked septic from across the room. Working hard to breath, tachycardic to 200, crying from abdominal pain, I can only imagine what his lactate was. His liver was enlarged, he had crackles throughout his lung fields. LFTs elevated, Albumin 1. Apparently he had started with a diarrheal illness a couple weeks ago and saw a traditional healer who prescribed him some country medicine at that time. Soon after, the parents noted some scleral icterus and felt like he was getting worse. He was admitted to an outside hospital with abdominal pain and treated for dysentary, but was transferred here for increased work of breathing and escalation of care. My thought is that he has acute liver injury from country medicine, but only the mythical toxicology lab will know.  For now we will do what we can.

Rudolf might go home on Monday. I shake his hand every morning and say "soon". He doesn't understand American English, but he understands soon. So does his mother. He has been working on walking  on his own and he is off all antibiotics. His wrist wound is almost completely healed and his mother will continue the dressing changes for his thigh wounds at home. I can't believe that he is the only one of the five boys that I wrote about who is walking out of this hospital healed. I've tried to find peace in that Hilaire and Derrik have escaped their intense suffering. I fantasize that Junior somehow healed at home. I'm not sure how I will ever get over Cedrik's death, but hopefully I will come to some understanding some day. 

As for Rudolf, I feel like seeing him walk out of the hospital will be the most beautiful thing I've ever seen.